1639684475 NPI number — THE HAND AND WRIST INSTITUTE PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639684475 NPI number — THE HAND AND WRIST INSTITUTE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HAND AND WRIST INSTITUTE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639684475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 E SOUTHLAKE BLVD STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-382-6789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 E SOUTHLAKE BLVD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-382-6789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-382-6789

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063458321 . This is a "INDIVIDUAL NPI NUMBER" identifier . This identifiers is of the category "OTHER".




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